Antibiotic Spacers in Shoulder Arthroplasty: Comparison of Stemmed and Stemless Implants.

Background: Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers. Methods: All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed. Results: There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, p = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; p = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m2 vs. stemmed group, 31.5 ± 8.3 kg/m2; p = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; p = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109° ± 23°. Within the stemmed group, 12 of 15 (80.0%, p = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94° ± 43° (range, 30° to 150°; p = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation. Conclusions: Stemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers

Conditional Lower Bounds for Space/Time Tradeoffs

In recent years much effort has been concentrated towards achieving polynomial time lower bounds on algorithms for solving various well-known problems. A useful technique for showing such lower bounds is to prove them conditionally based on well-studied hardness assumptions such as 3SUM, APSP, SETH, etc. This line of research helps to obtain a better understanding of the complexity inside P. A related question asks to prove conditional space lower bounds on data structures that are constructed to solve certain algorithmic tasks after an initial preprocessing stage. This question received little attention in previous research even though it has potential strong impact. In this paper we address this question and show that surprisingly many of the well-studied hard problems that are known to have conditional polynomial time lower bounds are also hard when concerning space. This hardness is shown as a tradeoff between the space consumed by the data structure and the time needed to answer queries. The tradeoff may be either smooth or admit one or more singularity points. We reveal interesting connections between different space hardness conjectures and present matching upper bounds. We also apply these hardness conjectures to both static and dynamic problems and prove their conditional space hardness. We believe that this novel framework of polynomial space conjectures can play an important role in expressing polynomial space lower bounds of many important algorithmic problems. Moreover, it seems that it can also help in achieving a better understanding of the hardness of their corresponding problems in terms of time

A Survey of Expert Opinion Regarding Rotator Cuff Repair.

Many patients with rotator cuff tears have questions for their surgeons regarding the surgical procedure, perioperative management, restrictions, therapy, and ability to work after a rotator cuff repair. The purpose of our study was to determine common clinical practices among experts regarding rotator cuff repair and to assist them in counseling patients. We surveyed 372 members of the American Shoulder and Elbow Surgeons (ASES) and the Association of Clinical Elbow and Shoulder Surgeons (ACESS); 111 members (29.8%) completed all or part of the survey, and 92.8% of the respondents answered every question. A consensus response (\u3e50% agreement) was achieved on 49% (24 of 49) of the questions. Variability in responses likely reflects the fact that clinical practices have evolved over time based on clinical experience

Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.

BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom durationmodel, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration \u3e270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration \u3c6 \u3eh. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification

Comparison of branded rugby headguards on their effectiveness in reducing impact on the head

Aim: To compare the available brands of rugby headguards and evaluate their impact attenuation properties at various locations on the cranium, with regard to concussion prevention.Methods: Seven different branded headguards were fitted onto a rigid headform and drop-tested in three different positions. An accelerometer measured the linear acceleration the headform experienced on impact with the ground. Each test involved dropping the headform from a height that generated 103.8 g on average when bare, which is the closest acceleration to the upper limit of the concussion threshold of 100 g. A mean peak acceleration for each drop position was calculated and compared with the bare baseline measurement.Results: Each headguard demonstrated a significant decrease in the mean peak acceleration from the baseline value (all p≤0.01). Overall the Canterbury Ventilator was the most effective headguard, decreasing the impact force on average by 47%. The least effective was the XBlades Elite headguard, averaging a force reduction of 27%. In five of the seven headguards, the right side of the headwear was the most effective at reducing impact force.Conclusion: Overall, the results indicate that it would be beneficial to wear a headguard during rugby in order to reduce the impact forces involved in head collisions. There was also a clear difference in performance between the tested brands, establishing the Canterbury headguard as the most effective. However, only one model of headguard from each brand was tested, so further research evaluating all other models should be considered.</p

Computational evidence for an early, amplified systemic inflammation program in polytrauma patients with severe extremity injuries

Extremity and soft tissue injuries contribute significantly to inflammation and adverse in-hospital outcomes for trauma survivors; accordingly, we examined the complex association between clinical outcomes inflammatory responses in this setting using in silico tools. Two stringently propensity-matched, moderately/severely injured (Injury Severity Score > 16) patient sub-cohorts of ~30 patients each were derived retrospectively from a cohort of 472 blunt trauma survivors and segregated based on their degree of extremity injury severity (above or below 3 on the Abbreviated Injury Scale). Serial blood samples were analyzed for 31 plasma inflammatory mediators. In addition to standard statistical analyses, Dynamic Network Analysis (DyNA) and Principal Component Analysis (PCA) were used to model systemic inflammation following trauma. Patients in the severe extremity injury sub-cohort experienced longer intensive care unit length of stay (LOS), total LOS, and days on a mechanical ventilator, with higher Marshall Multiple Organ Dysfunction (MOD) Scores over the first 7 days post-injury as compared to the mild/moderate extremity injury sub-cohort. The higher severity cohort had statistically significant elevated lactate, base deficit, and creatine phosphokinase on first blood draw, along with significant changes in multiple circulating inflammatory mediators. DyNA pointed to a sustained role for type 17 immunity in both sub-cohorts, along with IFN-γ in the severe extremity injury group. DyNA network complexity increased over 7 days post-injury in the severe injury group, while generally decreasing over this same time period in the mild/moderate injury group. PCA suggested a more robust activation of multiple pathways in the severe extremity injury group as compared to the mild/moderate injury group. These studies thus point to the possibility of self-sustaining inflammation following severe extremity injury vs. resolving inflammation following less severe extremity injury

De un proyecto, un libro Inglés para ciencias y tecnología. Lectura comprensiva de textos- FACET-UNT.

El aporte de la ciencia a la generación de conocimientos y el aumento del volumen de información científica en inglés manifiestan la necesidad de incluir el estudio de dicha lengua en la formación profesional. Esto enfatiza el rol interdisciplinario del idioma inglés en los planes de estudio y su función como instrumento de trabajo y de cultura. El dominio de al menos la habilidad de lectura en dicha lengua deviene condición indispensable para un poder hacer y crear acorde a la época. Inglés para Ciencias y Tecnología - Lectura Comprensiva de Textos surge entonces de la necesidad de proveer un texto, actualizado y con fines pedagógicos, que permita a hispanoparlantes con nulos o escasos conocimientos de idioma inglés, acceder a bibliografía de la especialidad.\ud El presente trabajo incluye una breve caracterización del discurso científico-técnico, la fundamentación teórica que sustenta el diseño de los contenidos del libro, así como ejemplos de algunos textos y actividades que en él se incluyen.\ud A través de esta presentación, intentaremos compartir con colegas dedicados a la enseñanza de lecto- comprensión de textos en inglés una propuesta pedagógica resultado de nuestra experiencia docente como profesores de inglés en la Facultad de Ciencias Exactas y Tecnología, UNT.\u

Distributed Edge Connectivity in Sublinear Time

We present the first sublinear-time algorithm for a distributed message-passing network sto compute its edge connectivity $\lambda$ exactly in the CONGEST model, as long as there are no parallel edges. Our algorithm takes $\tilde O(n^{1-1/353}D^{1/353}+n^{1-1/706})$ time to compute $\lambda$ and a cut of cardinality $\lambda$ with high probability, where $n$ and $D$ are the number of nodes and the diameter of the network, respectively, and $\tilde O$ hides polylogarithmic factors. This running time is sublinear in $n$ (i.e. $\tilde O(n^{1-\epsilon})$) whenever $D$ is. Previous sublinear-time distributed algorithms can solve this problem either (i) exactly only when $\lambda=O(n^{1/8-\epsilon})$ [Thurimella PODC'95; Pritchard, Thurimella, ACM Trans. Algorithms'11; Nanongkai, Su, DISC'14] or (ii) approximately [Ghaffari, Kuhn, DISC'13; Nanongkai, Su, DISC'14]. To achieve this we develop and combine several new techniques. First, we design the first distributed algorithm that can compute a $k$-edge connectivity certificate for any $k=O(n^{1-\epsilon})$ in time $\tilde O(\sqrt{nk}+D)$. Second, we show that by combining the recent distributed expander decomposition technique of [Chang, Pettie, Zhang, SODA'19] with techniques from the sequential deterministic edge connectivity algorithm of [Kawarabayashi, Thorup, STOC'15], we can decompose the network into a sublinear number of clusters with small average diameter and without any mincut separating a cluster (except the `trivial' ones). Finally, by extending the tree packing technique from [Karger STOC'96], we can find the minimum cut in time proportional to the number of components. As a byproduct of this technique, we obtain an $\tilde O(n)$-time algorithm for computing exact minimum cut for weighted graphs.Comment: Accepted at 51st ACM Symposium on Theory of Computing (STOC 2019